It’s pretty normal to feel shy or uncomfortable sharing certain information during appointments with your gynecologist.

Let’s start today’s topic off with a firm understanding of what role different doctors play in a woman’s life. A gynecologist is a doctor who specializes in women’s reproductive health. Obstetricians care for women during their pregnancy and just after the baby is born; they also deliver babies. An OBGYN, on the other hand, is trained to do all of these things. 

Now, because they deal with such personal and sensitive topics, the thought of visiting an OBGYN may make you feel nervous, embarrassed, and reluctant to discuss your most intimate issues with someone who is essentially a stranger. We get it, it may feel a little uncomfortable. So that’s why we’re here to take the dread out of your annual appointments with some tips on feeling more comfortable with your OBGYN and an idea of what you can expect at your checkups. 

When Should You First Visit the Gyno?

College should not be your first rodeo with a gynecologist. We highly recommend that between the ages of 13 and 15 you touch base with a gynecologist, find out what we do, and tell us a little about your medical history if you feel so inclined. It doesn’t have to be a super long or in-depth visit, but we find that in establishing a relationship with your gyno from a young age, you’re setting yourself up for a much better and more comfortable relationship later. If you don’t feel entirely comfortable disclosing to your gyno, find another provider. You have a choice in the matter because it’s your care. 

Preparing for Your Visit

Avoid having sex or douching within 24 hours of your pending appointment as this can irritate your vagina and impact the results of your Pap test. 

Before you even enter the office, you should be clear on the purpose of the visit. Not all visits require an exam. There are numerous other situations in which an exam is not necessary; for example, the first time you meet your gynecologist which mimics more of a meet and greet than a typical doctor’s office visit. Or maybe you just want to discuss your contraceptive options, family planning, your irregular periods, etc. But one thing is for sure: there shouldn’t be any surprises on either your or your provider’s end going into your appointment. 

What Happens at a Gynecologist Visit

When you get to your appointment, it is your gyno’s job to make sure everyone is on the same page and review how exactly how this exam will go. If an exam is taking place, have them go over the specifics that entails: will there be a breast or pelvic exam? How do these things work? It’s important to remember that nothing should be happening to you during your appointment without your consent or feeling “comfortable” about it. 

Your medical history should and will be discussed thoroughly including (but not limited to) your surgical history, current medications, family history, inquiries into your smoking, drinking, and drug habits, and reviewing medical issues you may have. Even though we’re a gynecologist, we aren’t here just to talk about your sexual history; getting to know you a little more personally in terms of your medical history helps us provide the best care to you that we possibly can. 

Generally, your appointment will start with a health check. The nurse will take your weight and blood pressure; you may also have to provide blood and urine samples. Then you’ll move into the physical exam in which you’ll be asked to undress and change into a gown that opens in the front and a sheet to cover your lap. 

Your OBGYN will ask you questions typically about your personal and family health history, periods and any problems they may cause, if you’re sexually active and how often, birth control options, vaccine history, and any sexually transmitted diseases you’ve had or think you might have. Questions might get personal but it’s important that you provide your doctor with completely honest answers for her/him to provide the best care possible. You should also use this time to ask questions that you might have about any of the above topics or more. You may feel embarrassed asking them but trust us when we say, we’ve heard it all before. 

As a part of your physical exam, the doctor will examine the outside of your vagina for abnormalities and then examine your reproductive organs from the inside. During this exam, your knees will be bent, your feet up in stirrups and the gynecologist will use a speculum to hold the vagina open while she exams it and your cervix. This shouldn’t feel painful, more like pressure. Your gyno will then take a sample of cells from your cervix using a small brush for a Pap test; the cells will then be sent to a lab and checked for abnormalities that could signify cervical cancer or HPV.

If you are sexually active, your doctor will likely test you for sexually transmitted diseases with a cotton swab during your pelvic exam and/or checking your blood test. Your OBGYN might also do a breast exam to check for any lumps or abnormalities.

After your exam, a nurse will follow up with any test results over the phone or by email. 

Your Mid-Atlantic Women’s Care physician and office staff will do everything within our power to make sure you understand the different elements of your exam and feel as comfortable as possible.

Menopause, which quite literally means the pause of menses (your period), is likely something you’ve heard of before: maybe from your mom or an older sister or friend. While some women can manage to skate right through this time with little to no symptoms, others experience all the classics: hot flashes, mood swings, night sweats, and trouble sleeping. But, although people are quick to talk about a few of the symptoms they’re experiencing, you will notice that far fewer people talk about the whole picture. That’s exactly why we’re here to give you the bigger picture of what life after menopause looks like. Knowing what you can expect can help to alleviate your worries, help you effectively treat your symptoms, and lower the risks of certain conditions and diseases that can come as a result. 

What is happening to my body during menopause?

The transition to menopause, formally called perimenopause, takes place over the course of several years. You’ll know you are officially in menopause when you have not gotten your period for 12 months straight. The ovaries gradually stop producing estrogen resulting in hormonal fluctuations as the body adjusts to what can be characterized as the shut-down of the ovaries. By the 12-month mark, your ovaries have significantly reduced the production of both hormones estrogen and progesterone. 

This can result in some metabolic and physiological changes that over time affect your body’s composition. 

Managing your menopause symptoms

Women often will try to manage their menopause symptoms on their own for fear of embarrassment in reporting the issues they’re experiencing to their provider. But there’s no need to be embarrassed and we encourage you to speak openly about your symptoms and work with your healthcare provider to find an effective treatment. That may come in the form of hormonal replacement therapy, non-medical methods like exercise and a modified diet, or other treatments tailored to your needs. 

Many of the changes that occur during menopause – anxiety, mood swings, and depression to name a few – are not physical changes but are the result of hormone changes. When coupled with physical changes, these emotional changes can wreak havoc on your life and sleep schedule. That’s why it’s so important to speak to your provider who can assist you in developing a treatment plan that’s right for you. 

What does life after menopause look like?

Life after menopause doesn’t have to look that different from life before, especially if you maintain an open line of communication with your doctor. 

There are some ways you can minimize your menopausal symptoms (we’ll talk a little more about that later) that can help you maintain a healthy lifestyle. But you should also make sure you are getting regular health screenings and staying up to date on vaccines in order to prevent health concerns from becoming a bigger deal later. 

What can I do to minimize my symptoms?

Increase exercise

Exercise, no matter the intensity, is highly beneficial for women who are post-menopausal. As we’ve mentioned, menopause can result in weight gain, so in order to counteract that change in body composition, physical activity is necessary. Want to know something pretty great? This is one area where being post-menopausal gives you a leg up: physical activity has a greater impact on your body after menopause than before. So even if you engage in light physical activity, you will likely see the positive effects. Small lifestyle changes like gardening and walking can make a big difference. 

Watch what you eat

The best way to maintain your target body composition may require a permanent change in your lifestyle and routine rather than the dieting approaches you may have taken in the past. Instead of taking a restrictive dieting approach, focus on just watching what you eat and drink; choose nutritious foods while limiting processed foods, alcohol, and sweets. 

Get plenty of sleep

A well-known result of menopause is a lack of sleep which can then affect hormones that control other aspects of your body. Practicing good sleep habits means trying to get 7-9 hours of sleep every night and implementing practices that promote quality sleep: regular exercise, decreased caffeine, avoiding long naps, establishing a relaxing bedtime routine, and creating a comfortable sleep environment.

Abnormal menstrual cycles are a difficult issue to pinpoint as hormones are a tricky subject and can impact a number of different factors and bodily systems. In order to understand how you can regulate menstruation and balance hormones naturally, it’s important to know the potential causes and lifestyle habits that can negatively affect your hormonal levels. 

Having a regular, moderately pain-free period each month is a good indication that your hormones are in balance and the reproductive system is working properly. But the opposite is also true: irregular and missed periods, or very painful, intense PMS symptoms could be a sign that your hormone levels are out of whack — either lacking or too high. 

The 8 Most Common Causes of Irregular or Missed Periods

Besides being pregnant and going through menopause, which both naturally stop a woman from getting her period, here are the other major causes of missed or irregular periods:

Cause #1: High Stress Levels

When you’re under a lot of stress for an extended period of time, your body makes an effort to conserve energy as a sort of fight or flight response. As a result, it will prevent ovulation because this is a process that your body sees as secondary when compared to survival. Several factors could contribute to this — experiencing a traumatic event, restricting your eating, and exercising an excessive amount could cause irregularity (repeated fight or flight). The body gives priority to producing stress hormones that will help you survive in a crisis, so sex hormone production takes a backseat. 

When estrogen level falls below normal, you aren’t able to build up the uterine lining (that you are shedding during your period) so as a result, you don’t get your period. 

Cause #2: A Poor Diet

A diet that’s low in nutrients, antioxidants, and probiotic foods yet high in stimulants takes a toll on the adrenal glands and thyroid. For example, eating a diet that’s high in sugar, hydrogenated fats, and artificial additives is linked with thyroid issues and adrenal fatigue that can raise cortisol. Excess cortisol hinders the function of many other essential hormones, including sex hormones. It also can lead to the breakdown of bones, skin, muscles, and brain tissue if you continue to maintain high levels over a long period of time. If you’re not experiencing regular menstruation, make sure you’re eating enough food and that’s the right kind: foods that are high in antioxidants, nutrient-dense, and with plenty of protein.

Cause #3: Extreme Weight Loss and Low BMI

When your body mass index (BMI) falls below 18 or 19, you may miss your period because of the lack of body fat, which is essential in the creation of estrogen. A diet that’s low in calories and fat can result in nutritional deficiencies that contribute to irregular periods and bone loss. This is not to say that every woman that experiences missed or irregular periods will be underweight or nutritionally deficient. Many are at a normal weight and some are even what is considered “overweight” on the BMI scale. (this might not need to be stated since the article is all about varied reasons periods are irregular)

Cause #4: Over-Exercising

Moderate exercise is essential to heart health, mood regulation, a good sleep schedule, and maintaining a healthy body weight, however, too much exercise can put excess pressure on your adrenal, thyroid, and pituitary glands. Women who start vigorously exercising (for example, you’ve started training for a marathon) can stop getting their period suddenly. The stress hormone, cortisol, will be released in response to a real or perceived stress, physical (like exercise) or emotional. With the societal pressures today for women to stay thin and in shape, some will feel they need to exercise more than a healthy amount. This kind of exertion can increase stress and deplete the body of energy that it needs to regulate and release sex hormones.

Cause #5: Thyroid Disasters

Although this may be an indiscernible problem, your thyroid can cause many issues related to hormonal imbalances. Studies have shown that thyroid disorders may actually be one of the leading causes of missed periods, affecting nearly 15% of amenorrhea patients. The thyroid gland largely controls your metabolism and impacts many sex hormones, therefore, thyroid disorders like hypothyroidism or hyperthyroidism can cause widespread symptoms like changes in estrogen and therefore missed periods. (shorten sentence, repetitive)

Cause #6: Change in Birth Control Methods

Some women will stop getting their period, somewhat intentionally, while on birth control and will notice that even when they stop the pill, their period doesn’t return. While we advise that a woman’s period should adjust within a few months of stopping the pill, many women will experience missed or irregular periods for years afterward. 

A woman’s menstrual cycle is composed of rising and falling levels of estrogen and progesterone, but when taking birth control pills, estrogen levels are sufficiently high to fool the body into thinking it’s pregnant, resulting in irregular periods. When you switch from one birth control method to another or quit birth control altogether, it can take the body many months or even years to return to homeostasis.

 Cause #7: Ongoing Hormonal Imbalances and Disorders

Polycystic ovarian syndrome (PCOS) is a hormonal imbalance in women that negatively impacts ovulation. A woman with PCOS experiences altered levels of sex hormones that can result in abnormal bodily functions including blood sugar problems, abnormal facial body hair growth, weight gain, acne, and irregular menstrual cycles. It can also lead to premature menopause, occurring prior to the age of 40, which can cause missed periods, hot flashes, night sweats, and vaginal dryness. 

Cause #8: Food Allergies and Sensitivities

An undiagnosed gluten sensitivity or celiac disease – meaning you are not taking medication or monitoring it – can both impact your hormone levels. These conditions can result in nutrient deficiencies, negatively affect gut health, and add chronic stress to your adrenal glands, which have the ability to affect sex hormone production.

While some of these causes are relatively unavoidable, it’s crucial that you are paying honest attention to how each element of your lifestyle affects your health; that way you can make choices to eliminate or tweak aspects that may be causing irregular periods. If you’ve been dealing with missed periods for a while, speak to your doctor about running some important tests that can find hormone imbalances and other issues. Many experts will recommend a three-tier treatment strategy that looks something like this: 1) Make appropriate diet, lifestyle, and stress-reduction changes; 2) Use natural remedies when you need extra support; and 3) Only if you find that those aren’t working, discuss hormonal pills or procedures with your healthcare provider. 

What is a Pap Smear?

A Pap smear, formally known as the Papanicolaou test, is a procedure in which cells are scraped from the cervix and examined using a microscope. The test is used to detect cell abnormalities that could potentially be a sign of cervical cancer or other conditions, such as infection, HPV, and inflammation. A Pap smear is the best means to discover precancerous conditions and concealed tumors that may lead to cervical cancer. 

So, what exactly happens during a Pap smear? Well, we’re glad you asked. When performing a Pap smear, your gynecologist will insert a speculum into the vagina in order to widen the opening and exam both the cervix and the vagina. The doctor then takes a sample of the cervical cells using either a small spatula or brush. These samples are then placed into a solution, transferred into a small glass slide, and sent to a laboratory for cytological examination. 

Why Should I Get a Pap Smear?

The primary benefit of a Pap smear test is that it screens for cervical cancer and has saved the lives of many women since it’s discovery in the mid-1900s. Cervical cancer occurs when cervical cells become abnormal and expand uncontrollably over time. The cancer cells invade deep into the cervical tissue and, in advanced cases, the cancer cells spread to other organs in the body.

What to Do If Your Pap Smear Is Abnormal

Pap test results can take as long as three weeks. If your test results come back normal, you can wait up to three years before your next Pap smear. 

If a test indicates that something is abnormal, it does not mean that you have cancer, but an abnormal test does mean that the cells of the cervix do not look normal. Because Pap smears are a screening test and not a diagnostic test, it cannot tell for certain that cancer is present. An abnormal test could indicate that there is inflammation or minor cell changes called dysplasia – these cells look abnormal but are not cancerous. 

Whatever the case may be, your doctor will contact you in order to schedule a follow-up. In many cases, immediate treatment can prevent cervical cancer from developing, so early detection and following up is critical. 

Most issues that end up being non-cancerous but are still detected in a Pap smear tend to clear up or go back to normal on their own. In order to verify that this is the case, your doctor will probably recommend having a follow-up test within the next few months.

How to Prepare For Your Pap Smear

When Should You Start Getting Screened?

Women should have a Pap smear every two years starting at the age of 21. After age 30, you may choose to receive the HPV test, performed at the same time as your Pap smear. You may also choose to decrease the frequency to every three years if you’re low-risk and have always had normal results up to this age. 

Despite what many women believe, you are never too old for a Pap test. Most women over 65 do not need Pap smears, but it may be necessary if you have had treatment for precancerous or cancerous cells in the past 20 years. However, women that have had regular screenings in the previous 10 years and haven’t had precancerous cells found in the last 20 years should stop cervical cancer screenings. 

Before Getting a Pap Smear

There are certain things that you must avoid doing prior to getting a Pap smear:

• Having sex
• Using a tampon
• Douching
• Using medicine or cream in your vagina
• Using spermicidal treatments

You’ll also want to avoid scheduling your Pap smear during your period because although the test can be done during a menstrual cycle, it is best to avoid that if possible. Cervical screening results are not always active and can sometimes show abnormal cells where they are not present. These are all things that can potentially cause a false-negative result due to the presence of inflamed cells. 

Don’t Skip Your Pap Smear

The momentary discomfort of a Pap smear is well worth the lifesaving results that can come from them. Pap smears are one of the most reliable cancer screenings currently available. 

It is important that you are taking your health needs into account that are specific to being a woman and not simply ignoring them. At Mid-Atlantic Women’s Care, we want to make sure you are healthy through all the seasons of your life. During your well-woman exam, your provider can screen for health problems and answer any of your questions and concerns.

Let’s face it: pregnancy can be uncomfortable. And it can be stressful. You have people on all sides telling you that it’s such a wonderful time, that every change your body is undergoing is completely normal and natural, and all the while, you’re feeling too guilty to admit that those physical changes are leaving you feeling stressed. 

The morning sickness, mood swings, fatigue, hunger, not to mention the weight gain almost makes it feel like you’re no longer in control of your body. 

We want to assure you that it’s perfectly okay to have these mixed feelings about all these life changes. If you’re feeling stressed about your pregnancy, take heart in the fact that there are many ways to make the time during your pregnancy easier and way less stressful and they all boil down to these two lifestyle changes:

1. Realize that you’ll have to develop new coping skills and routines during your pregnancy to carry over after the baby arrives. 
2. Take time to organize your life to accommodate pregnancy and a new family dynamic.

Develop New Coping Skills and Routines Now

One of the most important things for you to do at this time is to take a step back and look at your current lifestyle: are you making time for the most important things – family, friends, relaxation, hobbies? Is there room in your schedule to accommodate new lifestyle changes? 

It may be hard to wrap your mind around it, but many aspects of your reality will have to change during and after pregnancy. Ask yourself these important questions:

1. What aspects of my daily life are incompatible with my pregnancy or with a new baby? Maybe you commute by bicycle to work and will have to find another mode of transportation. Or maybe you go out with your partner every week and have a glass of wine with friends and you realize that you’ll have to find new places to hang out. Whatever it may be, taking stock of these changes before they need to happen will save you a lot of stress in the future.
2. How do I currently manage stress? Can I use these same methods during pregnancy? If not, what are some other methods I could try? Let’s say you used to meet for cocktails with your girlfriends to relieve stress after a long week. Maybe instead you and those same friends go to a yoga class and then meet for tea after. A much more pregnancy-friendly option.
3. How can my partner and I communicate productively? Good communication is absolutely key during this time. If you are feeling frustrated or need more from your partner, tell them. 
4. Are we financially prepared? It’s no secret that children can be expensive but with prior planning, it is completely manageable. Determine if you will need to adjust the household budget and how you want to go about doing that. Consult a professional if this is an area you don’t feel completely comfortable in.
5. Will it be beneficial to set boundaries with family? A new baby is an exciting time for both you and your family but you have to decide how intimate of an involvement you want between your baby, your family, and your in-laws. Are there certain topics you don’t want them involved in? Let them know that before the baby even arrives. 

If you need help evaluating these questions, don’t hesitate to consult with your provider. We’ve been through this many times and we’re here to help!

Organize Your Life to Minimize Stress

The best way to handle stress is to get ahead of it and this is just as applicable during pregnancy. If you modify your life as early as you can, then it won’t all hit you at once and knock you off your feet. Here are our suggestions:

• Formulate new routines early on in your pregnancy: Your life after the baby is born is going to look a bit different and it’s best to establish those new routines before that time comes. This might include meal prepping on the weekends, creating grocery lists rather than roaming around the store for hours, and making plans to see friends rather than relying on spontaneous hang-outs.
• Write things down: hormonal changes can cause pregnant women to become a little forgetful. It’s completely natural but there are also easy ways to combat this. Write down your new schedule, jot down reminders and to-do lists, record important dates in the calendar app on your phone and set reminders. If this isn’t something you do regularly, now is the perfect time to start.
• Create a list of activities that relieve stress for you so that before you even get stressed, you know exactly how to cope with it. Here are some ideas: going for a walk, meditating, taking a long bath, pampering yourself, getting a professional pedicure, etc.. 
• Find an unbiased sounding board: Find someone – a therapist, a local or online community of mothers, etc. – with whom you can speak openly about your stress. Because they have no involvement in your pregnancy but they do have knowledge of prior experience, they can provide you with feedback that gives you the reassurance that what you’re going through is normal. 

Have you ever heard the saying “an ounce of prevention is worth a pound of cure”? This quote is just as applicable in managing stress during pregnancy as with any medical procedure. Many women go through postpartum blues due to changes in hormones and lifestyle. Preparing for these changes prior to them occurring will help in keeping you grounded after your new baby is born.